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Are we losing the rehab battle?


YCAN - Are we losing the rehab battle?

A series of low buildings set in an Arizona desert is the unlikely site of one of the world’s pre-eminent addiction specialist centres. Here, some of the world’s most prominent addicts are treated. Overlooking mountains and fields of cactus plants, The Meadows is where designer John Galliano is widely rumoured to be seeking treatment for substance abuse which led to, allegedly, an anti-semitic outburst in a Paris cafe last month, his arrest and the termination of his contract with Christian Dior.

The Meadows has been operating for 35 years as a centre for excellence in the treatment of psychiatric disorders – but is principally a place to overcome addiction to drugs and alcohol. Ronnie Wood, Kate Moss, Elle Macpherson and Tiger Woods are all rumoured to have checked in at some point. Those names might make headlines – but 18,000 other patients from across the globe have been treated there since it opened.

Such is the Meadows’s success, David Cameron has requested an informal meeting with the centre’s senior clinical adviser, Pia Mellody, and CEO Jim Dredge when they come to Britain for a Europe-wide addiction conference in May.

“In the UK, you are looking at losing billions of dollars in opportunity. [Addiction] costs the country a lot of money,” says Dredge. “[The British Government] wants to know: 'Why are you so successful [with the treatment] and why are we [in Britain] failing?”

One problem is that we don’t know how big a problem addiction is in the UK. Kathy Gyngell, chair of the Centre for Policy Studies’ Prisons and Addictions, commented: “The US is well ahead of us in the game of social data collection… Here in the UK we only began collecting very selective aspects of treatment data… after the National Treatment Agency was set up in 2002.”

So why are American institutes such as The Meadows leading the charge when it comes to cutting-edge addiction therapy? Why, when a very public person comes undone, do we read that they are on the first plane either to Arizona or California (another hot bed of cutting-edge research) – and not Harley Street?

It is simple, says Mellody: “We are a private for-profit psychiatric hospital. We make money to be at the cutting edge of treatment.”

A patient who arrives for the four-week programme is assigned a team of up to six experts, including a primary therapist, a psychiatrist, and a nurse. A counsellor is assigned to the patient’s family.

Two new techniques being used at The Meadows are Eye Movement Desensitisation and Reprocessing – a form of psychotherapy that helps people resolve disturbing experiences by using visualisation – and somatic experiencing, a kind of trauma therapy that monitors small changes in the body as a patient discusses their abuse. It detects facial expressions, ticks and other small physical changes.

Another new technique being used at the equally renowned Promises treatment centre in Malibu – where Charlie Sheen and Lindsay Lohan are said to have sought treatment – is EEG biofeedback. It teaches patients to regulate their nervous system, by monitoring changes in brain waves.

“We have well-qualified practitioners who treat patients here with great respect. Privacy is paramount,” says Mellody. “People find their humanity here. The human struggle is the same for all of us – they need to 'hug their demons’ so to speak.”

It is clear that psychiatric hospitals in the UK pale in comparison to the centres in the US. Perhaps the best-known treatment centre in the UK is the Priory. One former patient described her treatment there to me. Aged 45, she was admitted after a visit to a private psychiatrist. She had been suffering severe “reactive depression” for a decade. Her GP would prescribe valium to “mask the pain”, she says. She ended up relying on a combination of valium and alcohol to treat her depression.

“I spent 28 days in The Priory in Roehampton – but it became clear my stay was about [me] being labelled 'an addict’ rather than treating my underlying depression and the traumas which had caused it.”

Unlike the facilities in the US, where patients see their psychiatrist and therapist daily, she saw her psychiatrist once a week.

“There was a sense of anarchy with some of the patients there, it was like One Flew Over the Cuckoo’s Nest. One patient would show up to the Narcotics Anonymous meetings drunk and AA meetings high.

“When you go to through the doors [of the Priory], you have to conform to being an addict. That was their mission. Most of the people who treated me in group therapy sessions were counsellors who were former addicts themselves, not doctors. I felt they needed to transfer their addiction on to counselling people. They were very comfortable amongst addicts.”

A spokesperson for the Priory Group said: “We are confident in the care and treatment offered at our hospitals. Consultant psychiatrists are required to see their patients a minimum of three times a week. Any patient who has been through the whole inpatient programme is offered free follow-up for one year. Almost half of all discharged patients stay in touch with services for a year.”

It is a world away from The Meadows – a former “dude ranch” (a Western horse riding outfit) where high-powered business men who had become alcoholics would go to dry out. Now it has expanded and can treat around 100 patients at once.

As a former alcoholic herself, Mellody realised that in most cases, addiction is a symptom that masks other psychiatric disorders. Anecdotal evidence suggests around 80 per cent of her patients have experienced some kind of trauma, often childhood abuse. This is also the key to treatment at the Promises treatment centre in Malibu, according to its CEO, Dr David Sack.

“Promises is very attuned to the fact that 30 to 50 per cent of our clients with drug and alcohol problems have other psychiatric diagnoses as well,” says Dr Sack. “Going back 50 years, most addiction centres treated just the drugs or alcohol problem but not the other psychiatric or mental health diagnoses.” A patient would detox or dry out and be sent on their way.

“Getting to the bottom of everything is a big part of the focus of the current treatment,” says Dr Sack. “If you don’t, the person is at a substantial higher risk of relapse.”

Patients at Promises can enjoy the centre’s garden, swimming pools, Jacuzzis, a tennis court, and numerous meditation areas with sweeping vistas of the Pacific.

“The day starts by going to a gym, followed by an individual therapy session, then group therapy, acupuncture, meditation, massage, EEG biofeedback and community self-help recovery groups in the evening. We are an abstinence-oriented programme – the best outcome is complete abstinence,” says Dr Sack.

At Promises, the minimum stay is 30 days and the longest 150 days. Nearly all patients start their treatment needing to be detoxed, as they are “using” right up until the time they arrive at the front door. Surprisingly, of all the substances alcohol withdrawal is the most serious, says Dr Sack. “There is a risk of seizures, circulatory collapse, delirium and hallucinations.”

No matter the luxurious surroundings, checking into a psychiatric hospital is not an easy step to take. The treatment is gruelling, and there is risk of relapse.

“The most common misperception is that we are running a spa”, says Dr Sack. In fact, he says, “We are running a treatment centre that looks like a spa.”

But whatever the luxury on offer, these so-called spas are outstripping our own treatment centres – and the gap looks set only to widen.

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YCAN - Are we losing the rehab battle?Are we losing the rehab battle?

A series of low buildings set in an Arizona desert is the unlikely site of one of the world’s pre-eminent

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